Geriatric Nursing

Elder Abuse Awareness Day June 15, 2009

2009-06-14T19:51:00.000-07:00

Monday 6/15/09 is Elder Abuse Awareness Day. I wanted to share 'What are the signs of Elder abuse?'
* Unexplained injuries, bruises, burns, puncture wounds, cuts, sunken eyes and/or welts.
* Excessive fears, withdrawal, agitation.
* Changes in appetite or unusual weight gain or loss.
* Poor personal hygiene.
* Unexplained changes in health, personality or behavior.
* Frequent arguments or tension between the elder and his/her caregiver.
* Unsanitary or unsafe living conditions.
* Unnecessary services. goods or subscriptions.
* Sudden inability to pay bills, buy food or personal items.
* Financial activity the elder could not have done.
* suspicious changes in wills, POA, titles and policies.

What can you do as a concerned friend or family member?
* If you suspect abuse, REPORT IT!
* Monitor the elder's medication
* Ask the elder if someone they trust could review their bank statements, credit card statements for unauthorized transactions.
* Pay attention to "new" friends
* Offer to assist the elder with household needs (lawn care, repair work, etc.)
* Call and visit as often as possible
* Get acquainted with the elder's neighbors-enlist their help.

Exploitation

2009-06-07T19:37:00.000-07:00

What does exploitation mean? According to the Washington Administrative Code (WAC) exploitation is defined as: an act of forcing, compelling or exerting undue influence over a resident causing the resident to act in a way that is inconsistent with relevant past behavior or causing the resident to perform services for the benefit of another (not their usual behavior). Because our elderly are often lonely or isolated due to inability to get out anyone extending a friendly hand is often welcomed. To help an elderly person not be a victim of exploitation when asking how they are doing be specific. Ask them how they are getting their groceries, assist them to utilize community available transport or locate grocery stores that offer a delivery service. When there is a scam reported in the news let the elderly people in your life know about the scam and how to protect themselves. The most important safeguard is to have frequent contact and if possible visit often. If you believe someone has been the victim of exploitation call the complaint resolution unit or Adult protective services for your area.

Elder Abuse conference

2009-05-30T17:19:00.000-07:00

I was fortunate to be able to attend the Elder Abuse Conference last week. There were several excellent speakers. The conference covered what constitutes abuse, how to recognize abuse, where to report abuse and some strategies to prevent abuse. Several case studies were shared and talked about how a perpetrator was able to swindle several thousand dollars out of unsuspecting elderly ladies in a senior mobile home park. One important point that was emphasized was to learn who your neighbors are or learn who the neighbors are of the elders you care about. Neighbors can be invaluable in terms of keeping an eye out and letting a family member know when when someone has been in the neighborhood that normally isn't. One of the attorney's that presented stated that had it not been for a neighbor who had written down the license plate number of the car of the perpetrator, the perpetrator may never have been caught and prosecuted.

I will include in the next several posts more information that was shared at the conference.
Have a great week.

Mesothelioma

2009-05-27T20:23:00.000-07:00

Mesothelioma: A Quiet Killer

Many of us are aware that lung cancer is the United States leading cause of death behind heart disease and that other cancers, such as breast cancer and prostate cancer are receiving a great deal of attention in recent years. But I wish to touch upon a type of cancer that very few people are aware of-mesothelioma. Mesothelioma accounts for only one percent of cancers in the United States each year, but nevertheless is likely the most devastating of all malignancies.

Given the recent advancements and investments in cancer research over the past 25 years, it is rare that patients are told by their physicians that there is nothing they can do to help them. Unfortunately, with mesothelioma patients, this is too often the norm. Mesothelioma forms in the lining of the body’s internal organs, most often in the cell wall that lines the lungs. As the tumor grows around the lung and chest wall, it begins to collapse chest expansion and limit breathing. Untreated disease often results in suffocation of the patient.

Mesothelioma is known only to be caused by asbestos exposure. Asbestos was an industrial insulation material used throughout different industries until it was found to be carcinogenic. Studies indicate that while mesothelioma is relatively rare at the present, incidence will increase in the next decade as the disease will often not manifest for 40-50 years after initial exposure to asbestos, meaning many are living right now who have the devastation of terminal cancer in their future.

What we need is more research into new therapies to treat mesothelioma, particularly given the expected rise in incidence. We need more physicians like Dr. David Jablons of the UCSF School of Medicine, who is experimenting with multi-faceted approaches and immunotoxin therapies for advanced disease. We need more national investment not only in cancers like lung and breast malignancies, but also rare cancers like mesothelioma. Progress we have made in recent years in the treatment of cancer in general can be attributed to this type of research and investment. Let’s extend that to all cancers, so that we may finally eradicate disease like mesothelioma.

Mesothelioma

2009-05-22T21:50:00.000-07:00

Mesothelioma

What is it?

Malignant mesothelioma is a rare type of cancer that occurs in the thin layer of cells lining the body's internal organs, known as the mesothelium. There are three recognized types of mesothelioma. Pleural mesothelioma is the most common form of the disease, accounting for roughly 70% of cases, and occurs in the lining of the lung known as the pleura. Peritoneal mesothelioma occurs in the lining of the abdominal cavity, known as the peritoneum and pericardial mesothelioma originates in the pericardium, which lines the heart.

Who is at risk for Mesothelioma?

The only recognized cause of mesothelioma is exposure to asbestos, though other factors such as smoking can make the disease more or less likely in some individuals. Industrial laborers were widely subjected to asbestos exposure on the job, as the material was widely used throughout the 20th century. Few of these workers knew they were being exposed to asbestos, however, despite the fact that many manufacturers were aware the material was hazardous. In most cases, mesothelioma symptoms will not appear in an individual exposed to asbestos until many years after the exposure has occurred. Those who believe they may have been exposed to asbestos should fill out our form to receive a free mesothelioma information packet, detailing treatment options, emerging therapies, and jobsite exposure information.

Mesothelioma Treatment

Once an individual has been diagnosed with mesothelioma, the next step is to discuss mesothelioma treatment options with his/her physician. Recent scientific research has produced significant breakthroughs with regard to treatment protocols for mesothelioma patients and more options are now available for managing the disease and supporting improved quality of life. Newly diagnosed patients always have many questions about the treatment options that would be most effective for them, including those about new treatment therapies like Alimta and Cisplatin and other chemotherapy drugs. In addition to these newer drugs that are being used to treat asbestos cancer, mesothelioma patients also have a number of "conventional" treatment options to consider, including chemotherapy, radiation therapy and surgery.

Clinical trials and experimental treatments are still other options that some mesothelioma patients may be eligible to participate in. Our site features a comprehensive mesothelioma cancer treatment section that includes important information for patients and families. We've included resources on top mesothelioma doctors such as Dr. Sugarbaker, as well as a comprehensive list of questions that you may wish to discuss with your personal physician when preparing a treatment plan. We are always providing new and informative resources regarding mesothelioma treatment including: Clinical Trials, conventional treatments, experimental therapies, and more. Check back often for the most recent advances in mesothelioma treatments.

Harvey Pass, M.D., NYU Medical Center

Dr. Harvey Pass is a top mesothelioma doctor and expert in the diagnosis and treatment of pleural mesothelioma, a type of lung cancer that is often related to asbestos exposure.

Asbestos Exposure

Asbestos exposure is the single known cause of mesothelioma. Inhaled or ingested asbestos fibers may cause an inflammation of internal tissue and disrupt organ function which leads to the development of the disease. Asbestos products were used extensively throughout the 20th century in a wide variety of applications. Many of these products were responsible for asbestos exposure sustained by both the individuals who manufactured the products as well as those who used them at commercial and industrial jobsites including shipyards, refineries, power plants, steel plants and more. Several asbestos companies continued to produce these products even after they were known to be hazardous and harmful to workers and their families. Those who have become sick because of exposure to these products may now be eligible for financial compensation if they were wrongfully exposed.

Asbestos was also used at many New York jobsites including Ground Zero and the former World Trade Center site. Common asbestos exposure sites in New York include the Brooklyn Navy Yard, Todd Shipyard, and the Con Edison power plant in New York City.

Veteran Support

Navy veterans who worked in navy shipyards and or served on our nation’s warships and submarine’s from WWII through the Vietnam War were exposed to high concentrations of deadly asbestos. Boiler rooms, engine rooms, sleeping quarters, and other areas of naval vessels were the most common areas where asbestos was present. As a result, Navy veterans are at a greater risk of developing mesothelioma. Veterans who were exposed should fill out the brief form on this page to receive a free mesothelioma and asbestos exposure information kit. Support systems are in place to make sure you receive the assistance you deserve.

News Alerts

Mesothelioma Treatment Option Found Effective

Lugano, Switzerland - May 23, 2009

A type of surgery used as part of a treatment plan for mesothelioma has recently been assessed by a major medical conference, and has been found to be very effective.

Firehouse Project Pushed Back Due to Asbestos Discovery

Vineland, New Jersey - May 22, 2009

Plans to demolish buildings to make way for a new firehouse have run into a snag: asbestos cleanup will be needed at the site.

Sixty-three Countries Approve United Nations Convention on Ship Recycling

Bangkok, Thailand - May 21, 2009

A new convention related to safety issues and the global shipbreaking industry has been approved by 63 world governments, according the United Nations. The goal is to update safety regulations within the shipbreaking industry in an effort to better protect workers.

Last modified: May 22 2009

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Elder abuse

2009-05-17T19:29:00.000-07:00

Abuse comes in all forms. This past week I learned of an elderly lady who was financially exploited by the caregivers she hired. She was progressing rapidly in her dementia and the caregivers were writing out checks to themselves forging her name. A bank teller picked up on something was not right; however this happened after several thousand dollars were taken.

One of the recommendations for aging deliberately is for all individuals who reach retirement age or before, decide how they wish their estate to be handled and make arrangements with someone they trust to follow their wishes. If there is no family there are means of setting up accounts at banks or through an attorney to establish a plan for one's estate.

Guest Post: Mesothelioma A quiet Killer

2009-05-05T13:34:00.000-07:00

Mesothelioma: A Quiet Killer
Many of us are aware that lung cancer is the United States leading cause of death behind heart disease and that other cancers, such as breast cancer and prostate cancer are receiving a great deal of attention in recent years. But I wish to touch upon a type of cancer that very few people are aware of-mesothelioma. Mesothelioma accounts for only one percent of cancers in the United States each year, but nevertheless is likely the most devastating of all malignancies.
Given the recent advancements and investments in cancer research over the past 25 years, it is rare that patients are told by their physicians that there is nothing they can do to help them. Unfortunately, with mesothelioma patients, this is too often the norm. Mesothelioma forms in the lining of the body’s internal organs, most often in the cell wall that lines the lungs. As the tumor grows around the lung and chest wall, it begins to collapse chest expansion and limit breathing. Untreated disease often results in suffocation of the patient.
Mesothelioma is known only to be caused by asbestos exposure. Asbestos was an industrial insulation material used throughout different industries until it was found to be carcinogenic. Studies indicate that while mesothelioma is relatively rare at the present, incidence will increase in the next decade as the disease will often not manifest for 40-50 years after initial exposure to asbestos, meaning many are living right now who have the devastation of terminal cancer in their future.
What we need is more research into new therapies to treat mesothelioma, particularly given the expected rise in incidence. We need more physicians like Dr. David Jablons of the UCSF School of Medicine, who is experimenting with multi-faceted approaches and immunotoxin therapies for advanced disease. We need more national investment not only in cancers like lung and breast malignancies, but also rare cancers like mesothelioma. Progress we have made in recent years in the treatment of cancer in general can be attributed to this type of research and investment. Let’s extend that to all cancers, so that we may finally eradicate disease like mesothelioma.

I would like to extend a thank you to Jack Bleaker for providing the guest post.

Elderly attributes

2009-05-04T12:13:00.000-07:00

This past weekend was a new experience. I was admitted to the hospital with chest pain, had ekg done and ended up with a heart cath. Amazing what stress can do if one is not paying attention to what the body is saying. Not an experience I would recommend, I do have to say the staff of nurses, doctors and nursing assistants were fantastic. I had the best care and am back home and doing normal activities.

Talking with a lovely elderly lady she was patient, supportive and let me know life goes on and this is just a little bump in the road. Enjoy each day as a gift for it is and make theday a wonderful memory. The elderly display such a calm position and reassurance that the sun will indeed come up in the morning.

I read an interesting quote today. If someone speaks ill of you, live your life in such a manner that no one would believe what they had said.

Listening the important skill

2009-03-17T07:43:00.000-07:00

Life gets so busy and people have so much to do that listening is not always easy. I had the privilege of visiting with a senior this week that was quite delightful. I thought if someone could just take ten minutes a day to spend with this lady so much of her loneliness would be lifted. Unfortunately the activities in the building do not provide enough stimulation for this lady. The activity program in assisted living centers are often times at the bottom of the priority for budgets. When there is a robust activity program facilities find they have less complaints and happier residents. We visited for about an hour and a half, hopefully she will take the initiative to explore more of what the facility has to offer.

Complaint Resolution Unit

2009-03-14T11:50:00.001-07:00

A reader wrote she had recently lost her mother and felt it was directly related to being neglected by the facility in which her mother was living. For the State of Washington there is the Complaint Resolution Unit (CRU) hotline number which is 1-800-562-6078. If you observe, or are treated in an abusive manner in a Nursing Home, Assisted Living Center or Adult Family Home call the hotline. This unit deals with abuse of vulnerable adults living in Nursing Homes, Assisted Living Centers, Boarding Homes, Alzheimer's units and Adult Family Homes.

For individuals living in their own home that experience abuse or observe someone being abused the number to call is the Adult Protective agency for your area. To report child abuse call the child protective services for your area.

I've added the CRU number underneath the title of the blog for easy reference.

My condolences to the lady and her family that recently loss their beloved mother. I lost my older brother to pneumonia January 31, 2009. This is a tough time for many.

Elder abuse

2009-03-12T16:18:00.000-07:00

Elder abuse is an escalating problem. It is a crime that is punishable and must be reported in every state. Federal and state regulations require certain professionals and institutions to report suspected cases, and they may be held responsible for failure to report suspected cases.

Elder abuse refers to cruel, inhumane treatment and malicious acts such as physical, mental, psychological, or sexual injuries that are perpetrated against an adult, 18 or older, who lacks the physical or mental capacity to provide for their daily needs and is unable to remove self from dangerous situations. The term also refers to the infringement of an elder's constitutional rights to dignity, freedom of choice, life, and privacy. Neglect refers to the willful deprivation of a vulnerable adult of adequate food, clothing, essential medical or rehabilitation treatment, shelter or supervision. Exploitation refers to any action which involves the misuse of a vulnerable adult's property, funds or person.

If a resident reports being upset due to specific treatment by an employee the incident must be investigated. As facility administration, you have the responsibility to keep all residents safe from abuse. Chances are good if one resident risks speaking up there are others experiencing similar treatment, but are afraid to tell anyone. Verbal or veiled threats to residents by caregivers is a form of abuse and requires investigation and reporting.

Resident Rights

2009-02-27T20:04:00.001-08:00

Some of the examples I have seen of resident right violations include; Residents being called sweetie, honey, babe, love. Residents have names and should be addressed by what they prefer to be called. Usually Mr. or Mrs. followed by their last name is appropriate. Residents should only be addressed by their first names if one is given permission to do so. Asking an individual how they prefer to be addressed establishes respect and provides dignity to the person. So many times residents have come to live in an assisted living because they have lost the ability to perform activities of daily living independently. Demonstrating kindness and respect only requires a bit of effort and time yet validates the individuals self worth and sense of dignity.

Resident Rights

2009-02-18T18:14:00.000-08:00

I am simply baffled at some of the things I see. Last week I came across an incident that I would think automatically would be viewed as a violation of resident rights and yet the situation was not handled with that level of urgency. In no situation would it be acceptable to refuse a resident breakfast for being 5 minutes late of the appointed meal time. An assisted living center is home to vulnerable adults and no one should be allowed the power to decide if a resident will or will not be served a meal because they are 5 minutes late. Hopefully the ombudsman will be in that facility next week to help establish a resident council and do some teaching on resident rights. Facilities that have active resident councils are better informed of resident rights and are more likely to engage the services of an appointed ombudsman.

For anyone who is not aware of what an ombudsman does, they are volunteers that go into facilities to assist residents in exercising their rights. They often will lend a voice to the resident's concern, or assist a resident in obtaining a service they need, or negotiate when there is a dispute. The ombudsman program for Washington State provides training for ombudsman and we are so fortunate to have as many as we do.

Time to answer the door.

2009-02-09T05:50:00.000-08:00

Last week I was in an assisted living facility and observed a resident knocking on a door to get the attention of staff. There were three staff in the room behind the closed door, but no one would open the door to see what this lady needed. This is the office that the residents are instructed to go to when they need assistance. Staff failing to answer the knocks on the door is a violation of resident rights. Finally a staff member did open the door and assist this lady. Fortunately we don't see that happen too often.

Sad Time

2009-02-04T16:59:00.000-08:00

We've had a loss in our family. My older brother passed away last Saturday from pneumonia, he was 66. He will be greatly missed by his family.

Vacation, New Year's give away

2009-01-13T06:42:00.000-08:00

The hardest part about vacation is coming back and trying to get caught up on everything. Well I'm back to work and full steam ahead. I'm trying a new schedule; getting up at 4 am exercising and getting ready for the day. This is my third day so hopefully I can stick it out until my birthday February 20th by then it will be a routine and will be the normal thing to do. Hope everyone had a good New Year's. Wanted to let people know that Phil's Grill is sponsoring a give away of a cool game 'Grilln'opoly. Go to http://www.grillingspecialties.blogspot.com for the details.
Geriatric Nurse

Thursday Thirteen #15

2008-12-17T20:53:00.000-08:00

Thirteen interesting nursing items from a 1916 nursing journal
1. The journal titled The Nurse dated February 1916
2. The journal cost $2.00 a year and 25 cents a copy
3. An article titled The graduate nurse and our alien exclusion laws.
4. Every Advertisement was guaranteed
5. Chr. Hansen's Junket Brand BUTTERMILK TABLETS ideal food for invalids and healthy people of all ages.
6. Questions by the Nurses' Examining Board of Vermont
7. The questions were listed under three categories; Practical Nursing & Dietetics, obstetrics, Materia Medica and Urinalysis
8. Invalid Danties by Riley M. Fletcher Berry
9. Advertisement for the The Chase Hospital Doll- description over 5 ft. tall made of finely woven stockinet, is durable waterproof and sanitary
10. Hospital methods illustrated: Hypodermoclysis - twenty engravings from photographs
11. The Role of the Visiting Nurse 'Keeping Up The District'
12. Philadelphia's Street Cleaning Nurse - In order that she may conduct her work most effectively, she has been legally empowered as a special police officer, which gives her the power of the law to make arrests when necessary.
13. An ad for Welsh's grape juice

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Thursday Thirteen #14

2008-12-10T19:28:00.000-08:00

Soothing Holiday Loneliness:

1. Look in the eyes, touch the hand, smile, and call the person by name.

2. Take time to be with the individual even when completing procedures.

3. Listen to stories.

4. Honor traditions.

5. Create gifts.

6. Use holiday music from the person's cohort.

7. Decorate with period ornaments.

8. Hold a holiday dance.

9. Have some special treats from the individuals' differing backgrounds (rum cake, Baklava, etc.)

10. Adopt a grandchild programs for those who have no family in the area is a way to bring children back into the holidays.

11. Arrange for carolers to come in and sing.

12. Warm apple cider and hot chocolate always brings a smile.

13. Hang the stockings with care.

Memories are precious. Too many holidays go by in which the memories of past holidays haunt and create want. We have the power to make them better by taking care to treat each person with consideration while helping them create a fond memory of this holiday.

Thursday Thirteen

Thursday Thirteen #13

2008-12-03T20:18:00.000-08:00

Thirteen ways to help residents in a dementia unit.

1. Play a selection of favorite resident Christmas carols.

2. Structure an activity of making simple Christmas ornaments.

3. Watch Christmas programming.

4. Tell Christmas stories.

5. Create a personal bulletin board decorated with family Christmas pictures.

6. Have a discussion about a resident's most memorable Christmas.

7. Try to schedule carolers to come to the facility.

8. Bake aromatic dishes that will provide wonderful smells of Christmas such as gingerbread.

9. Make gingerbread houses, decorate cookies.

10. Hang stockings.

11. Read poetry such as "The night before Christmas."

12. Serve apple cider or mold wine.

13. Don't forget the mistletoe, fresh pine garland or have Christmas potpourri.

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Thursday Thirteen

2008-11-20T06:41:00.000-08:00

Thirteen things I am grateful for
1. The time I had with my mother and father before they passes on.
2. The traditions they passed on to me.
3. The family recipes that were passed down and now I can give them to my daughter.
4. Our humble house to enjoy with family and friends.
5. To be able to enjoy the sights and smells of the holiday season.
6. Thankful all the noise is only temporary.
7. A good excuse to break out the photo albums and relive all those memories.
8. Friends and family with which to share Thanksgiving.
9. Humor that happens between people who care about one another.
10. Guests to play games with.
11. Promise for the future.
12. Good health and the ability to work.
13. The hope to be able to do it all over again next year.

Best wishes to everyone for a memorable happy Thanksgiving!
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Nurses

2008-11-18T17:32:00.000-08:00

I shouldn't be surprised at how different one nurse can be from another even though they work in the same industry Assisted Living. Nursing is like all professions, each professional determines how they will mold their career. I met a nurse today who has been a nurse for awhile however is new to the Assisted Living arena. She is very impressive and I believe will make wonderful contributions to the lives of the residents she serves. As I think about the qualities I observed about her I would say her sense of genuine caring was the hallmark. She thinks about what she is doing and how it will affect the whole community. When asked why she chose to do one thing a certain way rather than another her answer was immediate and her thought process was evident. I don't imagine she will do everything perfect, however look forward to working with her and perhaps learning a thing or two. Exposure to a new point of view is healthy.

Halloween evening of fun

2008-11-02T18:14:00.000-08:00

I always enjoy seeing all the costumes the children wear on Halloween. We usually have quite a few come by our house. My 2 year old granddaughter who lives in Georgia, her mom and dad took her to the mall to trick or treat. I am hoping for pictures.

Thursday Thirteen Edition #11

2008-09-24T00:53:00.000-07:00

13 positive features of an Assisted Living
1. You are greeted within seconds of entering the facility in a professional manner.
2. The facility smells clean.
3. Residents are involved with their surroundings and not just sitting.
4. There is a posted Activity calendar and you observe activities in progress.
5. There is a suggestion box/complaint box.
6. There is a menu that is posted in large lettering for residents to read.
7. Staff in the facility are pleasant, do not appear rushed, smile and greet you.
8. Staff interacting with residents in a friendly, caring, professional manner.
9. The facility is decorated like a home, with appropriate lighting, well maintained.
10. There is presence of an administrator, staff are visible.
11. Meal service is organized, well delivered, attractive, appetizing.
12. The outside grounds of the facility are well tended and attractive.
13. Sounds in the facility should reflect a calm comfortable atmosphere, be pleasant and inviting.

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High temperatures

2008-09-20T18:56:00.000-07:00

This past week I came across a situation that happened several months ago, in which a resident was running a high fever 102.6 he was left alone in his apartment and was not checked on all night. He experienced a fall, laid on the floor and was not found until the next morning several hours later. The caregiver who took the resident's temperature failed to intervene by not calling the facility nurse to report the high temperature, by not assisting the resident to get his Tylenol and by not checking on the resident to see that the temperature was reduced.
Orientation and training of facility policies and appropriate protocol for staff are so critical. Had the caregiver received the orientation and training that is required the outcome for this resident may have been prevented.
Also the facility managerial staff failed to do an investigation of the fall. If the investigation had been completed it would have come to light that this employee was lacking completion of the orientation.
The investigation should have included the who, what, when where, and why of the fall, the actions of the caregiver, and an evaluation of the training of the caregiver. Development of appropriate strategies to prevent the situation from happening again was also indicated.

Thursday Thirteen Edition #10

2008-09-17T19:43:00.001-07:00

13 suggestions for a fall risk assessment

1. History of falling
2. Cognition, mental status
3. Impulsivity
4. Vision (eye site elevated to target rather than looking at feet)
5. Ambulation ability
6. Continence
7. Use of high-risk medications
8. Use of assistive devices for transfer or ambulation
9. Attached equipment (oxygen tubing, catheters, intravenous lines)
10. Familiarity with the environment, lighting
11. Sleep patterns
12. balance, gait, footwear evaluation, appropriate shoes
13. Hydration status

This is only 13 suggestions and a thorough fall risk assessment should include additional factors that fits the make up of the facility.

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